June 14, 2007

Children in need: County struggles to provide child psychiatric services


Joe McIntyre/staff photographer
Tammy Olmstead talks with her son Jimmy while he romps around beneath a tree outside their Virgil home Wednesday. Jimmy, 12, has a severe developmental disability but can't get psychiatric services within Cortland County.

Staff Reporter

Tammy Olmstead’s son Jimmy, 12, was born with a rare chromosome disorder that has inhibited his growth and development.
He has the physical appearance of an 8-year-old and likely will remain developmentally at about 3 years old.
With no sense of fear, Jimmy requires constant one-on-one attention.
“Imagine what it’s like having someone holding your shirtsleeve every waking moment,” Olmstead said.
While Olmstead does her best to provide the best possible life for her son, she often finds herself at her wits’ end.
“Everyone thinks I’m a supermom. They ask how do I handle it,” Olmstead said. “The reality is I’m not handling it — I need help.”
Olmstead has not been able to find that help, in the form of psychiatric services for her son, in Cortland County.
What she needs, Olmstead said, is a child psychiatrist who can help her learn coping mechanisms and behavior management skills.
“But there’s nowhere to get that, not in Cortland,” she said.
Olmstead brought Jimmy to Cortland County’s Mental Health Clinic in the past, but found the clinic to be so overwhelmed with people in need that Jimmy couldn’t receive the attention his condition required.
With the recent resignation of the county’s only certified child psychiatrist from the Department of Mental Health and the county struggling find a replacement, the need for specialized services for children in the county has only grown.
“Child psychiatric services are the biggest service gap we have in this county,” said County Administrator Scott Schrader. “We’re attempting to meet an unmet need (at the Mental Health Department) … but even before all this, our own service had a waiting list upwards of two months and we weren’t able to meet the entire needs of the community.”
‘An absolute crisis’
Legislators were thrilled, in spite of a $205,000 annual salary, when Schrader announced in April an informal agreement with Dr. Naiyar Zaman, a certified child psychiatrist from Syracuse, to work as a staff psychiatrist at the Mental Health Department.
That excitement quickly turned to disappointment when Zaman unexpectedly turned down the county’s offer.
Meanwhile, shortly after initial plans to hire Dr. Zaman were announced, Dr. Edward Mehrhof, who had been working on a contractual basis for the department, resigned in May.
Mehrhof, the only certified child psychiatrist working in the county, had been working full-time hours to handle a caseload of roughly 700 patients.
Mehrhof said recently that part of the reason he left the department was an overwhelming workload, and an inability under those circumstances to give children the care they needed.
A typical day at the department saw Mehrhof scheduled to see patients 30 minutes at a time, right on top of one another, all day long, he said.
“That’s just not enough time to really make a difference for these patients,” Mehrhof said, noting that he’d requested a jump to 45 minutes per patient, but that that request had been denied due to the demand.
Since Mehrhof left the department, Dr. Susan Watrous, a psychiatrist at Horizon House, the county day treatment facility, has also announced her resignation, effective July 1.
Currently Watrous is filling in occasionally at the Mental Health clinic to fulfill a state requirement that a certified psychiatrist be on hand, and psychiatric nurse practitioner Jane Pendergast has continued to see adult patients, but neither has a specialty in handling child patients.
The Mental Health Department is referring a majority of its patients to their primary care physicians for any needed psychiatric prescriptions, said director of administrative services Mike Kilmer.
There are three private psychiatrists in the area that adult patients can be referred to, Kilmer said, but child patients are being advised to either continue with already prescribed medications from their physicians, or re-enter the process of meeting with department social workers that proceeds sessions with the department’s psychiatrist.
Dr. Mohammad Djafari, the Olmsteads’ physician, called the lack of child psychiatrists “an absolute crisis,” saying he sees many patients in need of psychiatric services, but has nowhere to send them.
“The rate is going up, you have kids with anger issues, with attention deficit, with bipolar disorders … they all need some level of psychiatric care, but they can’t get it, so it all falls back to the parents,” Djafari said. “If they have money, then they can maybe pay and see a private psychiatrist somewhere, but a large percentage of the county can’t afford that.”
With the Department of Mental Health sending many of its patients to their regular doctors for psychiatric drug prescriptions while it searches for a new psychiatrist, Djafari said many primary care physicians are put in an uncomfortable and potentially unethical position.
“The school is calling, the parents are upset, they can’t get in to see a psychiatrist, so what do you do? It all falls back on the primary care physicians … even though it’s not our specialty, we’re forced to do it because who else will?” he said. “What they need is a psychiatrist to look at them, everything else is just Band-aid stuff and isn’t going to solve the problem.”
Jackie Gailor, director of the county health department, said that she had heard numerous concerns from community members, from local school districts and from her own staff about the lack of child psychiatric services.
“There’s a huge need for child psychiatry, especially for children with special needs,” Gailor said. “Unfortunately the only way to get it right now is to go out of town.”
Unmet needs
Since Dr. Zaman turned down the county’s offer, Schrader and Kilmer have focused their attention on simply finding a psychiatrist, ideally one with some experience working with children.
This comes as no surprise to Tammy Olmstead, but is still a source of frustration.
“I got angry when I found out (the Mental Health Department) had applied for a grant to go into schools and screen kids for mental health issues, because they can’t even take care of the kids they already have,” Olmstead said of a state initiative that will give the county $50 for each child determined to be in need of services through a voluntary paper and pencil screening at area schools. “You know it’s going to fall back on the pediatricians because they just won’t be able to handle it all.”
Legislator Carol Tytler (D-3rd Ward) said that it was imperative that the county continue to push to find a child psychiatrist to try to meet the needs of parents like Olmstead.
She pointed out that a lack of child psychiatric services creates a trickle down effect when children in need are not effectively treated.
“I think it has a definite impact on our juvenile delinquent program, on PINS (persons in need of supervision),” Tytler said. “If families are in need of these services and they just can’t get them it’s going to have a wide-reaching effect on both the family and the community and we should make every effort to provide those services to them.”
Olmstead had to leave, in November, her work as a nurse — surrendering about 60 percent of her total income, she estimated — to take over caring for Jimmy full-time.
The county at one time provided her with a nurse to help out with Jimmy, but that service was stopped a few years ago when the nurse retired and the county had no one else to send, Olmstead said.
Jimmy is naturally becoming increasingly active and curious, but he still can’t be left alone in a room for any period of time, Olmstead said, and his condition leaves him prone to occasional psychotic episodes.
Olmstead said she is trying her best to cope, but added that she is looking in other areas such as Binghamton and Syracuse for someone capable of meeting Jimmy’s psychiatric needs.
“Nobody takes kids like Jimmy or works with kids like Jimmy around here, and the thing is, he’s not the only one,” Olmstead said. “There’s a lot of kids with disabilities who are so badly in need of the right care, and it’s just not available.”

Employment agency to help Mental Health Dept. find staff psychiatrist

The county Legislature’s Health Committee approved the use of an employment agency to help the Mental Health Department in its increasingly dire search for a staff psychiatrist.
The measure will go before the full Legislature June 28.
Should the agency find someone to fill the position, the county would have to pay a $28,000 fee, County Administrator Scott Schrader told the committee; however, the need for a psychiatrist is serious, he said.
“If we can’t find someone, we’re going to have to abandon our psychiatric services, which would be a huge disservice to the community,” Schrader said.
A psychiatrist is a certified medical doctor with a specialty in dealing with psychiatric issues.
Dr. Naiyar Zaman, a certified child psychiatrist, recently turned down an offer of $205,000 annually to serve as the county’s staff psychiatrist.
The department also saw the recent resignation of Dr. Edward Mehrhof, who had been serving as the primary psychiatrist for the department, and the pending July 1 resignation of Dr. Susan Watrous, a psychiatrist at Horizon House day treatment facility, who has been filling in occasionally for Dr. Mehrhof.
Schrader and Kilmer both told the committee that finding a psychiatrist has been difficult because the supply of psychiatrists nationwide is limited, and the demand is great.
The committee was amenable to Schrader’s request for hiring an employment agency, but Legislator Carol Tytler (D-3rd Ward) also suggested increasing efforts to promote Cortland County as a good choice over other suitors.
Tytler suggested purchasing a mailing list from the American Psychological Association to find names of potential candidates, and added that, on top of including a packet of information on the position, the packet also should include information from the Chamber of Commerce or BDC/IDA on what Cortland County has to offer.
“I think we need to try to sell that in this type of position, with this type of salary, this person will be able to have a very high standing and a very high quality lifestyle in this community,” Tytler said. “We need to sell this community.”
— Corey Preston


Cincy to begin cardiac program

Staff Reporter

A new program aimed at creating neighborhood cardiac response teams is scheduled to begin in Cincinnatus next month, with organizers hoping to eventually start similar programs throughout the county.
When a person goes into cardiac arrest, every minute that passes without treatment equates to a 10 percent chance of survival reduction, members of the county Legislature’s Health Committee learned Wednesday.
The odds of survival can be greatly increased by a quicker response time, said Sammy Suriani, an EMT from Manlius who founded the National Heart Safe Neighborhood Program.
Suriani asked the committee to make Cortland County a national flag bearer for his program, which creates Community Alert Response Teams made up of community members who are trained in CPR and on defibrillators, which if used in time can greatly increase the chances of surviving cardiac arrest.
The CART teams are trained extensively and are plugged in through the county’s 911 dispatch center to allow for a quicker response to cardiac emergencies.
In Suriani’s neighborhood, his CART team attended 47 calls in the last year, he said, and although it had never had to use a defibrillator, its response time was generally less than two minutes.
“Getting there quick enough can make all the difference,” he said.
Suriani said he expected to start the Cortland County program in Cincinnatus, where the fire department had already raised money to purchase defibrillators for individual EMS workers’ vehicles.
The department raised about $18,000 in 2005 to purchase between 10 and 15 defibrillators, but state legislation allowing the devices to be carried in EMS workers’ personal vehicles has been killed in the state Assembly twice.
Because regular citizens can use defibrillators without any state restrictions, Suriani’s program was a good fit, he said.


Homer OKs tax deal for housing project

Staff Reporter

HOMER — The Village Board approved a 15-year payment in lieu of taxes agreement for the 24-unit senior housing project at the corner of Cortland Street and Orson Drive at a special meeting Wednesday evening.
East Syracuse-based project developer Two Plus Four Construction will pay $16,500 in taxes its first year, and approximately $25,000 less in taxes over the 15-year period than it would without the agreement, according to estimates calculated by village Trustee Andy Brush.
Genevieve Suits was the only trustee to oppose the PILOT, saying Two Plus Four Construction shouldn’t get out of paying $25,000 in taxes.
“It’s fiscally irresponsible to give that money away,” she said.
Two Plus Four Construction sought a PILOT largely to know ahead of time how much it will pay in taxes over a 15-year period, according to company officials.
Prior to the vote, Brush suggested the board negotiate a PILOT with Two Plus Four Construction where the company would pay more than the plan before the board called for. Brush proposed a PILOT with payments of $500 per apartment unit per year the first five years, $600 per unit the second five years and $700 the last five years, compared to the $400, $500 and $600 figures in the plan before the board.
That would close the gap between the amount Two Plus Four Construction would pay with a PILOT and the amount it would pay without one.